|
HC NM LIVER BILE TRANSPORT W PHARM
|
Facility
|
OP
|
$1,506.09
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
34100073
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,506.09 |
| Rate for Payer: Aetna Commercial |
$1,355.48
|
| Rate for Payer: Aetna Medicare |
$541.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: ASR ASR |
$1,460.91
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,241.77
|
| Rate for Payer: BCN Commercial |
$1,241.77
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,204.87
|
| Rate for Payer: Cash Price |
$1,204.87
|
| Rate for Payer: Cofinity Commercial |
$1,415.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,460.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,506.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$541.02
|
| Rate for Payer: Mclaren Commercial |
$1,355.48
|
| Rate for Payer: Mclaren Medicaid |
$541.02
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$297.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.18
|
| Rate for Payer: Nomi Health Commercial |
$1,234.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,129.57
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$595.12
|
| Rate for Payer: PHP Medicaid |
$289.99
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,305.58
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,044.46
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,325.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$838.58
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP DNSP |
$541.02
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: VA VA |
$541.02
|
|
|
HC NM LIVER BILE TRANSPORT W PHARM
|
Facility
|
IP
|
$1,506.09
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
34100073
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,129.57 |
| Max. Negotiated Rate |
$1,506.09 |
| Rate for Payer: Aetna Commercial |
$1,355.48
|
| Rate for Payer: ASR ASR |
$1,460.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,236.80
|
| Rate for Payer: BCN Commercial |
$1,236.80
|
| Rate for Payer: Cash Price |
$1,204.87
|
| Rate for Payer: Cofinity Commercial |
$1,415.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.87
|
| Rate for Payer: Healthscope Commercial |
$1,460.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,506.09
|
| Rate for Payer: Mclaren Commercial |
$1,355.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.18
|
| Rate for Payer: Nomi Health Commercial |
$1,234.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,129.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,325.36
|
|
|
HC NM LIVER SPLEEN
|
Facility
|
IP
|
$936.94
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
34100016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$702.71 |
| Max. Negotiated Rate |
$936.94 |
| Rate for Payer: Aetna Commercial |
$843.25
|
| Rate for Payer: ASR ASR |
$908.83
|
| Rate for Payer: BCBS Trust/PPO |
$769.42
|
| Rate for Payer: BCN Commercial |
$769.42
|
| Rate for Payer: Cash Price |
$749.55
|
| Rate for Payer: Cofinity Commercial |
$880.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.55
|
| Rate for Payer: Healthscope Commercial |
$908.83
|
| Rate for Payer: Healthscope Whirlpool |
$936.94
|
| Rate for Payer: Mclaren Commercial |
$843.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$796.40
|
| Rate for Payer: Nomi Health Commercial |
$768.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$702.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$824.51
|
|
|
HC NM LIVER SPLEEN
|
Facility
|
OP
|
$936.94
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
34100016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$936.94 |
| Rate for Payer: Aetna Commercial |
$843.25
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$908.83
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$772.51
|
| Rate for Payer: BCN Commercial |
$772.51
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$749.55
|
| Rate for Payer: Cash Price |
$749.55
|
| Rate for Payer: Cofinity Commercial |
$880.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$908.83
|
| Rate for Payer: Healthscope Whirlpool |
$936.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$843.25
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$796.40
|
| Rate for Payer: Nomi Health Commercial |
$768.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$702.71
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$832.24
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$665.79
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$824.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM LOCALIZATION TUMOR LMTD AREA
|
Facility
|
OP
|
$807.35
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100052
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$807.35 |
| Rate for Payer: Aetna Commercial |
$726.62
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$783.13
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$665.66
|
| Rate for Payer: BCN Commercial |
$665.66
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$645.88
|
| Rate for Payer: Cash Price |
$645.88
|
| Rate for Payer: Cofinity Commercial |
$758.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$645.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$783.13
|
| Rate for Payer: Healthscope Whirlpool |
$807.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$726.62
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$686.25
|
| Rate for Payer: Nomi Health Commercial |
$662.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$605.51
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$719.67
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$575.74
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$710.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM LOCALIZATION TUMOR LMTD AREA
|
Facility
|
IP
|
$807.35
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100052
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$605.51 |
| Max. Negotiated Rate |
$807.35 |
| Rate for Payer: Aetna Commercial |
$726.62
|
| Rate for Payer: ASR ASR |
$783.13
|
| Rate for Payer: BCBS Trust/PPO |
$663.00
|
| Rate for Payer: BCN Commercial |
$663.00
|
| Rate for Payer: Cash Price |
$645.88
|
| Rate for Payer: Cofinity Commercial |
$758.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$645.88
|
| Rate for Payer: Healthscope Commercial |
$783.13
|
| Rate for Payer: Healthscope Whirlpool |
$807.35
|
| Rate for Payer: Mclaren Commercial |
$726.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$686.25
|
| Rate for Payer: Nomi Health Commercial |
$662.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$605.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$710.47
|
|
|
HC NM LOCALIZATION TUMOR MULTI AREA
|
Facility
|
IP
|
$1,314.50
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
34100054
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$985.88 |
| Max. Negotiated Rate |
$1,314.50 |
| Rate for Payer: Aetna Commercial |
$1,183.05
|
| Rate for Payer: ASR ASR |
$1,275.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,079.47
|
| Rate for Payer: BCN Commercial |
$1,079.47
|
| Rate for Payer: Cash Price |
$1,051.60
|
| Rate for Payer: Cofinity Commercial |
$1,235.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,051.60
|
| Rate for Payer: Healthscope Commercial |
$1,275.07
|
| Rate for Payer: Healthscope Whirlpool |
$1,314.50
|
| Rate for Payer: Mclaren Commercial |
$1,183.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.33
|
| Rate for Payer: Nomi Health Commercial |
$1,077.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$985.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,156.76
|
|
|
HC NM LOCALIZATION TUMOR MULTI AREA
|
Facility
|
OP
|
$1,314.50
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
34100054
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,314.50 |
| Rate for Payer: Aetna Commercial |
$1,183.05
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$1,275.07
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,083.81
|
| Rate for Payer: BCN Commercial |
$1,083.81
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,051.60
|
| Rate for Payer: Cash Price |
$1,051.60
|
| Rate for Payer: Cofinity Commercial |
$1,235.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,051.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,275.07
|
| Rate for Payer: Healthscope Whirlpool |
$1,314.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$1,183.05
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.33
|
| Rate for Payer: Nomi Health Commercial |
$1,077.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$985.88
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,151.76
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$921.46
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,156.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM LOCALIZATION TUMOR WHOLE BODY
|
Facility
|
OP
|
$1,769.69
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
34100055
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,980.48 |
| Rate for Payer: Aetna Commercial |
$1,592.72
|
| Rate for Payer: Aetna Medicare |
$541.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: ASR ASR |
$1,716.60
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,459.11
|
| Rate for Payer: BCN Commercial |
$1,459.11
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,415.75
|
| Rate for Payer: Cash Price |
$1,415.75
|
| Rate for Payer: Cofinity Commercial |
$1,663.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,415.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,716.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,769.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$541.02
|
| Rate for Payer: Mclaren Commercial |
$1,592.72
|
| Rate for Payer: Mclaren Medicaid |
$541.02
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$297.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,504.24
|
| Rate for Payer: Nomi Health Commercial |
$1,451.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,327.27
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$595.12
|
| Rate for Payer: PHP Medicaid |
$289.99
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,980.48
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,584.38
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,557.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$838.58
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP DNSP |
$541.02
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: VA VA |
$541.02
|
|
|
HC NM LOCALIZATION TUMOR WHOLE BODY
|
Facility
|
IP
|
$1,769.69
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
34100055
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,327.27 |
| Max. Negotiated Rate |
$1,769.69 |
| Rate for Payer: Aetna Commercial |
$1,592.72
|
| Rate for Payer: ASR ASR |
$1,716.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,453.27
|
| Rate for Payer: BCN Commercial |
$1,453.27
|
| Rate for Payer: Cash Price |
$1,415.75
|
| Rate for Payer: Cofinity Commercial |
$1,663.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,415.75
|
| Rate for Payer: Healthscope Commercial |
$1,716.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,769.69
|
| Rate for Payer: Mclaren Commercial |
$1,592.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,504.24
|
| Rate for Payer: Nomi Health Commercial |
$1,451.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,327.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,557.33
|
|
|
HC NM LUNG PERF DIFF FUNCT
|
Facility
|
IP
|
$850.11
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$637.58 |
| Max. Negotiated Rate |
$850.11 |
| Rate for Payer: Aetna Commercial |
$765.10
|
| Rate for Payer: ASR ASR |
$824.61
|
| Rate for Payer: BCBS Trust/PPO |
$698.11
|
| Rate for Payer: BCN Commercial |
$698.11
|
| Rate for Payer: Cash Price |
$680.09
|
| Rate for Payer: Cofinity Commercial |
$799.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.09
|
| Rate for Payer: Healthscope Commercial |
$824.61
|
| Rate for Payer: Healthscope Whirlpool |
$850.11
|
| Rate for Payer: Mclaren Commercial |
$765.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$722.59
|
| Rate for Payer: Nomi Health Commercial |
$697.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$637.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$748.10
|
|
|
HC NM LUNG PERF DIFF FUNCT
|
Facility
|
OP
|
$850.11
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$850.11 |
| Rate for Payer: Aetna Commercial |
$765.10
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$824.61
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$700.92
|
| Rate for Payer: BCN Commercial |
$700.92
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$680.09
|
| Rate for Payer: Cash Price |
$680.09
|
| Rate for Payer: Cofinity Commercial |
$799.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$824.61
|
| Rate for Payer: Healthscope Whirlpool |
$850.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$765.10
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$722.59
|
| Rate for Payer: Nomi Health Commercial |
$697.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$637.58
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$744.87
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$595.93
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$748.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM LUNG PERFUSION EG PARTICULATE
|
Facility
|
OP
|
$1,041.20
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
34100032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,041.20 |
| Rate for Payer: Aetna Commercial |
$937.08
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$1,009.96
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$858.47
|
| Rate for Payer: BCN Commercial |
$858.47
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Commercial |
$978.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,009.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,041.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$937.08
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.02
|
| Rate for Payer: Nomi Health Commercial |
$853.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$964.20
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$771.36
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$916.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM LUNG PERFUSION EG PARTICULATE
|
Facility
|
IP
|
$1,041.20
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
34100032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$780.90 |
| Max. Negotiated Rate |
$1,041.20 |
| Rate for Payer: Aetna Commercial |
$937.08
|
| Rate for Payer: ASR ASR |
$1,009.96
|
| Rate for Payer: BCBS Trust/PPO |
$855.03
|
| Rate for Payer: BCN Commercial |
$855.03
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Commercial |
$978.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Healthscope Commercial |
$1,009.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,041.20
|
| Rate for Payer: Mclaren Commercial |
$937.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.02
|
| Rate for Payer: Nomi Health Commercial |
$853.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$916.26
|
|
|
HC NM LYMPHATIC SENTINAL NODE IMAGING
|
Facility
|
IP
|
$1,340.69
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
34100012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,005.52 |
| Max. Negotiated Rate |
$1,340.69 |
| Rate for Payer: Aetna Commercial |
$1,206.62
|
| Rate for Payer: ASR ASR |
$1,300.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,100.97
|
| Rate for Payer: BCN Commercial |
$1,100.97
|
| Rate for Payer: Cash Price |
$1,072.55
|
| Rate for Payer: Cofinity Commercial |
$1,260.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,072.55
|
| Rate for Payer: Healthscope Commercial |
$1,300.47
|
| Rate for Payer: Healthscope Whirlpool |
$1,340.69
|
| Rate for Payer: Mclaren Commercial |
$1,206.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,139.59
|
| Rate for Payer: Nomi Health Commercial |
$1,099.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,005.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,179.81
|
|
|
HC NM LYMPHATIC SENTINAL NODE IMAGING
|
Facility
|
OP
|
$1,340.69
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
34100012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,340.69 |
| Rate for Payer: Aetna Commercial |
$1,206.62
|
| Rate for Payer: Aetna Medicare |
$541.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: ASR ASR |
$1,300.47
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,105.40
|
| Rate for Payer: BCN Commercial |
$1,105.40
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,072.55
|
| Rate for Payer: Cash Price |
$1,072.55
|
| Rate for Payer: Cofinity Commercial |
$1,260.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,072.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,300.47
|
| Rate for Payer: Healthscope Whirlpool |
$1,340.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$541.02
|
| Rate for Payer: Mclaren Commercial |
$1,206.62
|
| Rate for Payer: Mclaren Medicaid |
$541.02
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$297.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,139.59
|
| Rate for Payer: Nomi Health Commercial |
$1,099.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,005.52
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$595.12
|
| Rate for Payer: PHP Medicaid |
$289.99
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$625.86
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health Narrow Network |
$500.69
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,179.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$838.58
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP DNSP |
$541.02
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: VA VA |
$541.02
|
|
|
HC NM MECKELS OR ABD
|
Facility
|
OP
|
$1,168.96
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
34100021
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,168.96 |
| Rate for Payer: Aetna Commercial |
$1,052.06
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$1,133.89
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$963.81
|
| Rate for Payer: BCN Commercial |
$963.81
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$935.17
|
| Rate for Payer: Cash Price |
$935.17
|
| Rate for Payer: Cofinity Commercial |
$1,098.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$935.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,133.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,168.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$1,052.06
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$993.62
|
| Rate for Payer: Nomi Health Commercial |
$958.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$876.72
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,120.99
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$896.79
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,028.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM MECKELS OR ABD
|
Facility
|
IP
|
$1,168.96
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
34100021
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$876.72 |
| Max. Negotiated Rate |
$1,168.96 |
| Rate for Payer: Aetna Commercial |
$1,052.06
|
| Rate for Payer: ASR ASR |
$1,133.89
|
| Rate for Payer: BCBS Trust/PPO |
$959.95
|
| Rate for Payer: BCN Commercial |
$959.95
|
| Rate for Payer: Cash Price |
$935.17
|
| Rate for Payer: Cofinity Commercial |
$1,098.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$935.17
|
| Rate for Payer: Healthscope Commercial |
$1,133.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,168.96
|
| Rate for Payer: Mclaren Commercial |
$1,052.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$993.62
|
| Rate for Payer: Nomi Health Commercial |
$958.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$876.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,028.68
|
|
|
HC NM MYOCARD PERF SPECT EF WM MU
|
Facility
|
OP
|
$5,230.77
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
34100029
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$674.66 |
| Max. Negotiated Rate |
$5,230.77 |
| Rate for Payer: Aetna Commercial |
$4,707.69
|
| Rate for Payer: Aetna Medicare |
$1,289.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,612.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,612.49
|
| Rate for Payer: ASR ASR |
$5,073.85
|
| Rate for Payer: BCBS Complete |
$708.46
|
| Rate for Payer: BCBS MAPPO |
$1,289.99
|
| Rate for Payer: BCBS Trust/PPO |
$4,312.77
|
| Rate for Payer: BCN Commercial |
$4,312.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,289.99
|
| Rate for Payer: Cash Price |
$4,184.62
|
| Rate for Payer: Cash Price |
$4,184.62
|
| Rate for Payer: Cofinity Commercial |
$4,916.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,184.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,289.99
|
| Rate for Payer: Healthscope Commercial |
$5,073.85
|
| Rate for Payer: Healthscope Whirlpool |
$5,230.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,289.99
|
| Rate for Payer: Mclaren Commercial |
$4,707.69
|
| Rate for Payer: Mclaren Medicaid |
$1,289.99
|
| Rate for Payer: Mclaren Medicare |
$1,289.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,354.49
|
| Rate for Payer: Meridian Medicaid |
$708.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,483.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,418.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,446.15
|
| Rate for Payer: Nomi Health Commercial |
$4,289.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,923.08
|
| Rate for Payer: PACE Medicare |
$1,225.49
|
| Rate for Payer: PACE SWMI |
$1,289.99
|
| Rate for Payer: PHP Commercial |
$1,418.99
|
| Rate for Payer: PHP Medicaid |
$691.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,289.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$674.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,180.73
|
| Rate for Payer: Priority Health Medicare |
$1,289.99
|
| Rate for Payer: Priority Health Narrow Network |
$2,544.59
|
| Rate for Payer: Railroad Medicare Medicare |
$1,289.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,603.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,289.99
|
| Rate for Payer: UHC Exchange |
$1,999.48
|
| Rate for Payer: UHC Medicaid |
$674.66
|
| Rate for Payer: UHCCP DNSP |
$1,289.99
|
| Rate for Payer: UHCCP Medicaid |
$674.66
|
| Rate for Payer: VA VA |
$1,289.99
|
|
|
HC NM MYOCARD PERF SPECT EF WM MU
|
Facility
|
IP
|
$5,230.77
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
34100029
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,923.08 |
| Max. Negotiated Rate |
$5,230.77 |
| Rate for Payer: Aetna Commercial |
$4,707.69
|
| Rate for Payer: ASR ASR |
$5,073.85
|
| Rate for Payer: BCBS Trust/PPO |
$4,295.51
|
| Rate for Payer: BCN Commercial |
$4,295.51
|
| Rate for Payer: Cash Price |
$4,184.62
|
| Rate for Payer: Cofinity Commercial |
$4,916.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,184.62
|
| Rate for Payer: Healthscope Commercial |
$5,073.85
|
| Rate for Payer: Healthscope Whirlpool |
$5,230.77
|
| Rate for Payer: Mclaren Commercial |
$4,707.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,446.15
|
| Rate for Payer: Nomi Health Commercial |
$4,289.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,923.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,603.08
|
|
|
HC NM MYOCARD PERF SPECT EF WM SI
|
Facility
|
IP
|
$1,868.13
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
34100067
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,401.10 |
| Max. Negotiated Rate |
$1,868.13 |
| Rate for Payer: Aetna Commercial |
$1,681.32
|
| Rate for Payer: ASR ASR |
$1,812.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,534.11
|
| Rate for Payer: BCN Commercial |
$1,534.11
|
| Rate for Payer: Cash Price |
$1,494.50
|
| Rate for Payer: Cofinity Commercial |
$1,756.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,494.50
|
| Rate for Payer: Healthscope Commercial |
$1,812.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,868.13
|
| Rate for Payer: Mclaren Commercial |
$1,681.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,587.91
|
| Rate for Payer: Nomi Health Commercial |
$1,531.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,401.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,643.95
|
|
|
HC NM MYOCARD PERF SPECT EF WM SI
|
Facility
|
OP
|
$1,868.13
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
34100067
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$674.66 |
| Max. Negotiated Rate |
$1,999.48 |
| Rate for Payer: Aetna Commercial |
$1,681.32
|
| Rate for Payer: Aetna Medicare |
$1,289.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,612.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,612.49
|
| Rate for Payer: ASR ASR |
$1,812.09
|
| Rate for Payer: BCBS Complete |
$708.46
|
| Rate for Payer: BCBS MAPPO |
$1,289.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,540.27
|
| Rate for Payer: BCN Commercial |
$1,540.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,289.99
|
| Rate for Payer: Cash Price |
$1,494.50
|
| Rate for Payer: Cash Price |
$1,494.50
|
| Rate for Payer: Cofinity Commercial |
$1,756.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,494.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,289.99
|
| Rate for Payer: Healthscope Commercial |
$1,812.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,868.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,289.99
|
| Rate for Payer: Mclaren Commercial |
$1,681.32
|
| Rate for Payer: Mclaren Medicaid |
$1,289.99
|
| Rate for Payer: Mclaren Medicare |
$1,289.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,354.49
|
| Rate for Payer: Meridian Medicaid |
$708.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,483.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,418.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,587.91
|
| Rate for Payer: Nomi Health Commercial |
$1,531.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,401.10
|
| Rate for Payer: PACE Medicare |
$1,225.49
|
| Rate for Payer: PACE SWMI |
$1,289.99
|
| Rate for Payer: PHP Commercial |
$1,418.99
|
| Rate for Payer: PHP Medicaid |
$691.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,289.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$674.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,840.05
|
| Rate for Payer: Priority Health Medicare |
$1,289.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,472.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,289.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,643.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,289.99
|
| Rate for Payer: UHC Exchange |
$1,999.48
|
| Rate for Payer: UHC Medicaid |
$674.66
|
| Rate for Payer: UHCCP DNSP |
$1,289.99
|
| Rate for Payer: UHCCP Medicaid |
$674.66
|
| Rate for Payer: VA VA |
$1,289.99
|
|
|
HC NMO/AQP4 FACS TITER SERUM
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200395
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.03 |
| Max. Negotiated Rate |
$104.04 |
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: ASR ASR |
$100.92
|
| Rate for Payer: BCBS Trust/PPO |
$85.44
|
| Rate for Payer: BCN Commercial |
$85.44
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$100.92
|
| Rate for Payer: Healthscope Whirlpool |
$104.04
|
| Rate for Payer: Mclaren Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.56
|
|
|
HC NMO/AQP4 FACS TITER SERUM
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200395
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$213.06 |
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$100.92
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$85.78
|
| Rate for Payer: BCN Commercial |
$85.78
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$100.92
|
| Rate for Payer: Healthscope Whirlpool |
$104.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$93.64
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.03
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$213.06
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$170.44
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC NMO/AQP4-IGG CBA, S
|
Facility
|
IP
|
$358.94
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$358.94 |
| Rate for Payer: Aetna Commercial |
$323.05
|
| Rate for Payer: ASR ASR |
$348.17
|
| Rate for Payer: BCBS Trust/PPO |
$294.76
|
| Rate for Payer: BCN Commercial |
$294.76
|
| Rate for Payer: Cash Price |
$287.15
|
| Rate for Payer: Cofinity Commercial |
$337.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.15
|
| Rate for Payer: Healthscope Commercial |
$348.17
|
| Rate for Payer: Healthscope Whirlpool |
$358.94
|
| Rate for Payer: Mclaren Commercial |
$323.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.10
|
| Rate for Payer: Nomi Health Commercial |
$294.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.87
|
|
